House Heads for Showdown

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Speaker Nancy Pelosi (D-Calif.) appears to be on a collision course with moderates over the long-term costs of the health care overhaul she is shepherding through the chamber.

Moderates are still trying to plot their strategy but are feeling a new sense of urgency to try to stop Pelosi from bringing a bill to the floor that fails to rein in health care spending and bloats the deficit. Those lawmakers want to act now to rework the bill rather than face a scramble after a tough review from budget scorekeepers.

I dont think our Members are aware that where the bill is now is not going to meet the tests of either of those, according to CBO, and they havent made any changes that would, one senior Democratic aide said. Were getting toward the end and no changes are being made.

Pelosi spokesman Nadeam Elshami said the fiscal concerns voiced by moderates were shared by everybody in the Caucus. He noted that leaders are still gathering input to form the final bill and havent set a deadline for shipping it to CBO. Pelosi herself on Wednesday described the package as going around the bend though not yet in the final stretch.

But House Democratic moderates see a bill coming together that lacks fundamental changes such as a tax on high-cost insurance plans or a tough Medicare cost-cutting panel. Without them, they fear Congressional Budget Office Director Douglas Elmendorf will restate his July assessment  that the House bill increases the long-term cost trajectory for health care rather than cuts it.

The big picture is the presidents veto threat, said Rep. Jim Cooper (D-Tenn.), a leading member of the fiscally conservative Blue Dog Coalition. He said he would veto a bill that added a dime to the deficit in the short term or the long term. It would be embarrassing if we send him a bill that doesnt do that.

Those fears come as the Senate Finance Committee bill was preliminarily scored by CBO as actually cutting the deficit by $81 billion over the next decade with an $829 billion price tag, which had Senate Finance Chairman Max Baucus (D-Mont.) boasting.

Part of the problem in the House, moderates say, is that a tax on the wealthy that Pelosi has said were pretty much committed to doesnt do anything to contain health care costs and wont grow fast enough to keep up with rising medical costs long term.

The bill I had to vote on in committee increased the deficit by $239 billion over 10 years, and it gets a lot worse in the second 10 years, said Rep. Jason Altmire (D-Pa.), a leading member of the business-friendly New Democrat Coalition and a member of the Education and Labor Committee.

Many of us are continuing to feel strongly that not enough is done on sustainability, said Rep. Stephanie Herseth Sandlin (D-S.D.), a Blue Dog co-chairwoman. If were going to extend benefits for coverage, we have to be able to sustain this over the long term. This is one of the primary reasons were undertaking health care reform.